Conclusion

In completing the task which the author has attempted in the foregoing
chapters in the History of the Insane in the British Isles, he is only
too conscious that, in the endeavour to be concise as well as
comprehensive, he has made many omissions. With every desire to be fair
to all who have been engaged either in originating or in advancing the
improved treatment of those who, suffering cruelly from a malady
involving their very nature and being, have also been treated cruelly by
their fellows, the writer fears that some names which ought to have been
recorded and some institutions which ought to have been honourably
mentioned, have been passed over in silence. Apart from unintentional
oversight, it is not always easy to find in the Temple of Fame the
precise niche in which to place the figure that would rightfully fill
it, and the consequence is that the pedestal, as in some of our great
public edifices, remains unoccupied. It may be said, however, in
extenuation of any such omission, that it did not fall within the scope
of this book to chronicle all the establishments which, in more humane
methods of treatment, have been in advance of others, still less to
complete the history up to the present day of those which have been
mentioned. As it proceeded, the work has entered more into detail than
was originally designed; thus, in the chapter on Scotland the sketch is
filled in with particulars somewhat out of proportion to that attempted
in the earlier chapters.

Again, in crediting various asylums, as Lincoln, Hanwell, and Lancaster,
with introducing non-restraint, the author has not found space for more
than a reference to the meritorious course pursued at an early period at
the Suffolk Asylum, the Gloucester Asylum, and at Northampton from its
opening (1838), and at the Haslar Hospital.[314]

The writer would have been glad, had the proposed limits of the book
admitted of it, to describe much more fully the rise and growth of those
charitable institutions, the endowed or registered hospitals for the
insane, which have in England formed so important, and, on the whole, so
successful, an experiment in providing care and treatment for the insane
of the poor but non-pauper class, supplemented as they have been by the
payments of the rich. At the present moment, the principle and the
method by which these institutions are governed attract much earnest
attention, and appear to not a few to afford the best alternative
provision for the middle and upper classes, as against asylums carried
on by private enterprise. It may be so. Abuses which in former days were
possible, could not occur under the legislative restrictions of our
time; but it must not be overlooked that their annals have disclosed,
in some instances, abuses as great and inhumanities as shocking as any
that have disgraced the history of private houses. How abominably even
such institutions have been managed, has already been depicted in a
notorious example; how admirably, might have been shown, had space
allowed, as regards the same institution in the hands of men who, like
Dr. Needham, have maintained the reforms previously introduced within
its once dishonoured walls, and carried forward that humane system of
treatment which, Phoenix-like, arose from its ashes. The author would
have liked to do justice to other hospitals--as that at Northampton,
which under Dr. Bayley's remarkable power of organization has proved so
great a success; that at Cheadle, which under Mr. Mould's exhaustless
energy has shown how the various needs of different phases of mental
disorder may be met by various modifications in the provision made for
their care outside the walls of the asylum, thus combining cottage
treatment with the control of the central establishment; and, lastly,
that at Coton Hill, Stafford, which now and for many years has been
superintended by Dr. Hewitson--an institution due to a wave of public
feeling in favour of an institution for those in reduced circumstances,
which bore this practical fruit after some temporary discouragement.

Of the work done by county asylum superintendents it is impossible to
speak too highly; in fact, it would be difficult to know when to stop,
were one to be mentioned. Superintendents of the vast asylums of
Middlesex, Lancashire, and Yorkshire deserve the recognition of
services performed day by day with faithful diligence, not always
sufficiently appreciated, and not always without peril, as instanced in
the case of the late superintendent of Brookwood, Dr. Brushfield.[315]

As of those whose hourly labour is performed in these and other
institutions, so of those who were labourers, however humble, in the
early days of asylum reform at the close of the last and the beginning
of the present century, it must never be forgotten that work unobserved
by the public eye, but conscientiously performed for the unfortunate
class which, to a large extent, is unable to appreciate or thank the
kindly hand which shields them from cruelty or saves them from neglect,
will find its reward in the conscience; and also in the increased
happiness of those whom it benefits, though it may not set the worker on
any pinnacle of fame. It is to such that the author of "Romola" refers
when speaking of the "valiant workers whose names are not registered
where every day we turn the leaf to read them, but whose labours make a
part, though an unrecognized part, of our inheritance, like the
ploughing and the sowing of past generations."

FOOTNOTES:

[314] See Report of the Metropolitan Commissioners. 1844.

[315] Since the above was in type, another example has occurred in the
case of Dr. Orange, who has been assaulted by a criminal lunatic, and
narrowly escaped serious injury.

APPENDIX A.

(Page 61.)

In addition to the maps of Ralf Agas (cir. 1560?) and Braun and
Hogenberg (1572), there is an earlier view of London and Westminster by
Anthony van der Wyngrede, 1543, in the Bodleian Library, Oxford, but it
is worthless for the purpose of tracing the outline of Bethlem. No
additional light is thrown on the buildings by the view of London and
Westminster in Norden's "Speculum Brittanniae," engraved by Pieter van
dem Keere, 1593. It appears to be agreed that, whatever the date or
designer of the so-called "Agas" may be, it is "the earliest reliable
survey of London." Virtue's reprint is dated 1737. Mr. Overall's
"Facsimile from the original in the possession of the Corporation of the
City of London" was published in 1874. It is, however, only by a careful
study of the original with a magnifying glass and a good light, that the
outline of the Bethlem buildings can be made out.

Smith, in his "Topography of London" (1816), p. 36, says that the only
plan of London showing the first Bethlem which he had been able to meet
with is that by Hollar. This map showed Moorfields divided into
quarters, with trees surrounding each division, the site of the second
Bethlem being then an uninterrupted space, and a cluster of five
windmills standing on the site of the north side of Finsbury, a part of
which in Mr. Smith's memory was called Mill Hill. Hollar's rare map
(1666 or 1667) is so much later than Agas, that we have not followed its
distribution of the buildings. In Faithorne's map, published a few years
earlier (1658), from a survey in 1640, "Bedlame" is represented as a
quadrangle, with a gate in the wall on the south side. There is a very
clear outline of the first Bethlem in Lee and Glynne's map of London (in
Mr. Gardner's collection), published at the Atlas and Hercules, Fleet
Street, without date. This map is also in the British Museum. Mr. Coote,
of the Map Department, fixes the date at about 1705. Rocque's map of
London (1746) shows Bethlem distinctly. This map, and Ogilby's, formed
the basis of Mr. Newton's "London in the Olden Time," 1855.

With regard to the story of the skeleton in irons and Sir T. Rowe's
burying-ground, mentioned at p. 49, it is not disputed that he was
concerned in the burying-ground of Bethlem; but the skeleton appears to
have been found some distance from this spot. What is stated in Strype's
"Stow" (Bk. ii. p. 96, edit. 1720), is that in 1569 "Sir Thomas Rowe
caused to be enclosed with a wall about one acre, being part of the said
hospital of Bethlem, to wit, on the west, on the bank of Deep Ditch,
parting the hospital from Moorfields. This he did for burial in case of
such parishes of London as wanted ground convenient within their
parishes. This was called New Churchyard near Bethlem."

There are some very fine prints of the second Bethlem Hospital in the
Print Room of the British Museum. Of these (to which Mr. Crace's
collection is a recent valuable addition), and the prints in Mr.
Gardner's private collection and the Guildhall Library, the following
list has been prepared. I have again to thank Mr. Gardner and Mr. Coote
for their assistance. I have also to thank Mr. Crace for allowing me to
see his prints before they were removed to the British Museum.

In reference to the writers on insanity at the close of the eighteenth
century, Dr. Pargeter, in the work referred to at p. 142, after dwelling
slightly on the pathology, causation, and nature of insanity, becomes
disheartened and exclaims, "Here our researches must stop, and we must
declare that wonderful are the works of the Lord and His ways past
finding out" (p. 15). Of asylums he says, "The conduct of public
hospitals or institutions for the reception of lunatics needs no remark;
the excellence in the management of them is its own encomium" (p. 123).
Of private madhouses under the management of regular physicians, he
ventured to say that "people might securely trust that in them the
afflicted would be judiciously and tenderly treated, and also managed by
servants selected and instructed with such judgment as will make them as
zealous of their own character and reputation, as of the honour of their
employers. In such hands we may place implicit confidence; and a perfect
assurance that in such an abode dwells nothing offensive or obnoxious
to humanity--here no greedy heir, no interested relations will be
permitted to compute a time for the patient's fate to afford them an
opportunity to pillage and to plunder. But such dwellings are the seats
of honour, courtesy, kindness, gentleness, mercy, and whatsoever things
are honest and of good report." Such was the comfortable satisfaction
with which a worthy man in 1792 regarded the condition of the insane in
English asylums in that year. He admits, however, that in private
asylums kept by illiterate persons, compassion as well as integrity is
oftentimes to be suspected, and quotes a passage from a paper written in
1791, which asserts that "if the gaolers of the mind do not find a
patient mad, their oppressive tyranny soon makes him so."

The work written by Dr. Mason Cox (Fishponds, near Bristol) was the best
medical treatise of the day on insanity. Unlike Cullen, he objects to
"stripes" in the treatment of the insane. On the cold bath he says,
"Even so late as Boerhaave we have the most vague directions for its
employment; such as keeping the patient immersed till he is almost
drowned, or while the attendants could repeat the Miserere.... The mode
recommended and so successfully practised by Dr. Currie of Liverpool is
certainly the best, that of suddenly immersing the maniac in the very
acme of his paroxysm; and this may be easily accomplished if the
patient, previously secured by a strait waistcoat, be fixed in a common
Windsor chair by strong broad straps of leather or web girth" (p. 135,
3rd edit., 1813). The author observes that it is certainly worth trying
whether keeping a patient for days in succession in a state of
intoxication would be beneficial, where every other means has failed (p.
75).

APPENDIX C.

(Page 146.)

ASYLUMS IN OPERATION IN 1792.

Bethlem Hospital. Used for lunatics about 1400.

St. Luke's Hospital. Founded 1751.

Liverpool Royal Lunatic Hospital, associated with the Royal Infirmary.
1792.

Manchester Royal Lunatic Hospital, in connection with the Royal
Infirmary. 1706. (Removed to Cheadle, 1849.)

Bethel Hospital, Norwich. 1713.

The Lunatic Ward of Guy's Hospital. 1728. (New building, 1797.)

The York Lunatic Hospital, Bootham. 1777.

St. Peter's Hospital, Bristol. Incorporated 1696.

Brooke House, Clapton (Dr. Monro's). 1759.

Hoxton Asylum. 1744.

Fonthill-Gifford, Hindon, Wilts. 1718.

Droitwich Asylum. 1791.

Belle Grove House, Newcastle-on-Tyne. 1766.

Lea Pale House, Stoke, near Guildford. 1744.

Ticehurst, Sussex. 1792.

The number of lunatics in London and in the country, returned under the
Act of 1774 (14 Geo. III., c. 49), from that year to the projection of
the York Retreat (1792), was 6405; and from 1792 to the Select Committee
of 1815, 12,938.

In 1775 the number registered during the year was 406; and in 1791,
after various rises and falls, it was also 406.

In 1792 the number rose to 491, and in 1815 to 850; the lowest being 414
in 1807, and the highest 700 in 1812.

The above list of asylums shows how scanty was the provision made for
the care of the insane at the time of the foundation of the York
Retreat. I may here add that, in addition to the notice taken of this
experiment by the writers on the Continent mentioned in the text, the
attention of the Germans was forcibly directed to it by Dr. Max. Jacobi,
of Siegburg. He visited York, and, much struck by what he witnessed
there, translated into German the greater part of the "Description of
the Retreat." The late superintendent of the Retreat, Dr. Kitching, who
filled that office for many years with much efficiency, spent a
considerable time at the Siegburg Asylum, comparing notes with Dr.
Jacobi.

APPENDIX D.

(Page 173.)

9 GEO. IV., C. 40 (1828).

The fifteen persons appointed Commissioners in Lunacy for the
metropolitan district, five of whom were physicians, were paid L1 an
hour, and were appointed for one year. They were to meet quarterly for
the purpose of granting licences, those in the provinces being granted
by justices at quarter sessions, where three or more justices were to be
elected to visit the provincial licensed houses, together with at least
one medical Visitor.

Three of the Commissioners were to visit licensed houses in the
metropolitan district four times a year.

Two justices to visit licensed houses in the provinces, accompanied by
the medical Visitor, four times a year.

An annual report was to be prepared and presented to the Secretary of
State for the Home Department.

Private patients were not to be admitted to asylums without the
certificates of two medical men and an order; the certificates being in
force fourteen days before admission.

Pauper patients were not to be admitted without one medical certificate
and the order of two justices, or an overseer and clergyman.

The proprietor of an asylum had to transmit a copy of documents to the
Commissioners or justices, as the case might be.

Single patients to be received on like order and certificates. No
regular visitation of this class instituted.

It should be stated that among the previous Acts, now repealed, there
was a small Act passed May 2, 1815, notwithstanding the failure of Mr.
Rose to induce Parliament to undertake legislation based on the evidence
given before the Committee of that year. This was the Act 55 Geo. III.,
c. 46, entitled, "An Act to amend an Act 48 Geo. III., c. 96 (1808),
being an Act for the better Care and Maintenance of Lunatics being
Paupers or Criminals in England."

The committee of visiting justices of lunatic asylums were to be elected
annually.

Subscribers to lunatic asylums erected by voluntary contributions, who
should unite with any county, might elect a committee of governors to
act with committee of visiting justices.

Justices to fix sums to be expended in purchase of lands, houses, etc.,
or in erecting buildings.

Overseers of the poor to return lists of all lunatics and idiots within
their parishes, verified on oath and accompanied with a medical
certificate.

When any asylum could accommodate more lunatics, magistrate might order
an addition under certain regulations.

APPENDIX E.

(Page 188.)

8 AND 9 VICT., C. 100 (1845).

The following are the clauses of the Act which provide for the expense
of carrying out its provisions.

By this statute it was enacted, after repealing 2 and 3 Will. IV., c.
107; 3 and 4 Will. IV., c. 64; 5 and 6 Will. IV., c. 22; 1 and 2 Vict.,
c. 73; 3 Vict., c. 4; 5 and 6 Vict., c. 87, that the Commissioners in
Lunacy under 5 and 6 Vict., c. 84, should be henceforth called "the
Masters in Lunacy," and that new Commissioners in Lunacy should be
appointed. The Commissioners were to grant licences for the reception of
lunatics within a certain jurisdiction of the metropolis; justices of
the peace in general or quarter sessions licensing houses for the
reception of lunatics and appointing Visitors in all other parts of
England and Wales, including a medical man. For every licence granted a
sum to be paid of ten shillings for every private patient and two
shillings and sixpence for every pauper, or so much more as shall make
up the sum of fifteen pounds, these moneys being applied towards the
payment of the expenses of the Commissioners or any charge incurred by
their authority. The secretary of the Commissioners to make out an
annual account of moneys received and paid by him in the execution of
the Act, to be laid before the Lords Commissioners of the Treasury, the
balance (if any) to be paid into the Exchequer to the account of the
Consolidated Fund, such accounts being laid before Parliament every
year, the Treasury being empowered to pay out of the Consolidated Fund
any balance of payments over receipts which may be necessary. With
regard to the application of moneys received by the clerk of the peace
for provincial licences, they were to be applied towards the payment of
the clerk to the Visitors for the county, and the remuneration of the
medical Visitors, and other expenses incurred in the execution of the
Act, the accounts being laid before the justices at the general or
quarter sessions, who shall direct the balance (if any) to be paid into
the hands of the treasurer of the county or borough in aid of the rate;
any balance of payment over receipts being paid out of the county or
borough funds.

There was paid into the Exchequer in the year ending March 31, 1880,
L1376 for licences in the metropolitan district, besides L18 stamps.
Lunacy Board expenses, L15,064.

I have not any accurate returns of the amounts received from the
provincial houses, but on a rough estimate these licences produce to the
counties in the aggregate L1452, and L30 to the Imperial Exchequer, per
annum.

In the following year, August 26, 1846, an Act was passed "to amend the
Law concerning Lunatic Asylums and the Care of Pauper Lunatics in
England," and was to be construed with 8 and 9 Vict., c. 126. There were
only twelve sections. It was passed to clear up doubts which had been
entertained as to the meaning of certain clauses in the above Act. It
was repealed by 16 and 17 Vict., c. 97.

APPENDIX F.

(Page 190.)

After the legislation of 1853, the Acts referred to at p. 190 and p. 188
constituted, with 8 and 9 Vict., c. 100, and 15 and 16 Vict., c. 48, and
the Acts relative to criminal lunatics, the then code of Lunacy Law.

Lord St. Leonards' first Act, p. 188 (16 and 17 Vict., c. 70), enacts
that when the Commissioners shall report to the Lord Chancellor that
they are of opinion that the property of any lunatic, not so found by
inquisition, is not duly protected, or the income thereof not duly
applied for his benefit, such report shall be deemed tantamount to any
order or petition for inquiry supported by evidence, and the case shall
proceed as nearly as may be in all respects as therein directed upon the
presentation of a petition for inquiry.

The next Act (16 and 17 Vict., c. 96) prescribes amended forms of orders
and certificates, notices of admission, and of the medical visitation
book.

The requirements on the part of the medical man signing the certificate
are laid down.

Empowers proprietors or superintendents of licensed houses (with consent
of Commissioners) to entertain as a boarder any patient desiring to
remain after his discharge, or any relation or friend of a patient.

Authorizes amendment of any order or certificate within fourteen days
after admission of patient.

Permits the Commissioners to allow medical visitation of single patients
less frequently than once a fortnight.

Empowers one or more Visitors to visit single patients at request of
Commissioners, and report to them their condition.

Directs that the medical man who visits a single patient shall make an
annual report to the Commissioners of the mental and bodily health of
such patient.

Empowers the Lord Chancellor to discharge single patients.

Directs that notice of the recovery of every patient shall be sent to
his friends, or in case of a pauper to his parish officers, and in case
of death of a patient in any hospital or licensed house, a statement of
the cause, etc., to the coroner.

Authorizes transfer of a private patient (with consent of two
Commissioners) from one asylum, hospital, or licensed house to another,
without any fresh order or certificate, and similarly as to single
patients.

Empowers the Lord Chancellor, on the representation of the
Commissioners, to require a statement of the property and application
of the income of any person detained as a lunatic under an order and
certificates.

Extends to the Commissioners the powers vested in the private committee,
as to single patients, by the Act 8 and 9 Vict., c. 100, s. 111.

Repeals s. 27 of 8 and 9 Vict., c. 100, as to the visitation of
workhouses; and enacts that one or more Commissioners shall visit such
workhouses as the Board shall direct.

Authorizes the Commissioners in urgent cases to employ any competent
person to visit any lunatic and to report to them.

Directs committee of every hospital to submit regulations to the
Secretary of State for approval, and to send a copy to Commissioners.

Empowers Commissioners, with sanction of the Secretary of State, to make
regulations for the government of licensed houses.

Enacts that Bethlem Hospital shall be subject to the provisions of Act 8
and 9 Vict., c. 100.

The third Act (16 and 17 Vict., c. 97) repeals the several Acts then in
force respecting county and borough lunatic asylums, and re-enacts most
of the provisions therein contained, with certain additions and
improvements.

It authorizes justices of boroughs, instead of providing asylums for
their own use, or in arranging with counties, etc., to contract with the
Visitors of any asylum for the reception of their pauper lunatics, in
consideration of certain payments.

The powers of the Visitors were enlarged in many ways.

When a county or borough asylum can accommodate more than its own pauper
lunatics, the Visitors are empowered to permit the admission of the
pauper lunatics of any other county or borough, or lunatics who are not
paupers, but proper objects to be admitted into a public asylum, such
non-pauper patients to have the same accommodation, in all respects, as
the pauper lunatics.

The Visitors are directed to appoint a medical officer to be
superintendent of the asylum.

They are empowered to grant superannuation annuities to the officers
and servants.

They are directed to make an annual report to the general or quarter
sessions of the state of the asylum.

Every pauper lunatic, not in an asylum, hospital, or licensed house, is
to be visited every quarter by the medical officer of the parish or
union, who is to make return thereof; and the medical officer is to be
paid two shillings and sixpence for every visit.

The forms of orders, statements, and medical certificates are amended,
and the medical officers of unions are permitted to sign certificates.

The medical man certifying is required to state his qualification, when
and where the patient was examined, and to specify facts indicating
insanity; distinguishing facts observed by himself from those
communicated to him by others.

Visitors are empowered to order the removal of pauper patients to and
from asylums, and also to discharge or permit the absence on trial of
any patient. The Commissioners are empowered to direct the removal of
any lunatic from any asylum, hospital, or licensed house to any other.

The person signing the order for admission of a private patient into an
asylum may discharge such patient, subject, in the case of dangerous
lunatics, to the consent of the visiting justices. Any person having
authority to discharge a private patient is empowered (with consent of
two Commissioners) to transfer him to another asylum or to the care of
any person.

Orders and certificates, if defective, may be amended within fourteen
days.

Patients escaping may be retaken within fourteen days.

This statute did not re-enact the clause contained in the Act it
repealed respecting workhouses.

18 AND 19 VICT., C. 105 (1855).

In 1855 was passed the Act 18 and 19 Vict., c. 105, "to amend the
Lunatic Asylum Acts and the Acts passed in the Ninth and Seventeenth
Years of Her Majesty, for the Regulation of the Care and Treatment of
Lunatics."

By this statute it was enacted that any single county or borough might
unite with the subscribers to a registered hospital, and that the
proportion of expenses between any county and borough might be fixed
with reference to accommodation likely to be required.

Other sections provide in detail for the maintenance of county and
borough asylums, and other matters which it is unnecessary to enumerate.

APPENDIX G.

(Page 195.)

A short summary is added of the provisions in force at the time of the
Select Committee of 1859-60, for the protection of private patients.
They remain essentially the same.

In the metropolis, the power of licensing is exclusively in the hands of
the Metropolitan Commissioners. In the provincial districts it rests
with the justices at quarter sessions. These licenses are annually
renewed, and they may be revoked by the Lord Chancellor. The patients
are admitted upon an order signed by some relative or friend, with a
statement of all the particulars of the case. This statement must be
supported by the certificates of two medical practitioners, who, having
examined the patient separately within seven days previous to the
reception, state that he is a person of unsound mind, and a proper
person to be detained under care and treatment. It must also specify the
grounds upon which their opinion has been formed, viz. the facts
observed by themselves or communicated by others. After two and before
the expiration of seven clear days, the proprietor or superintendent of
the licensed house must transmit to the Commissioners, and also to the
visiting justices, if the licensed house is within their jurisdiction, a
copy of the order and certificates. The licensed house must be visited
by two of the Commissioners, four times at least every year, if it lies
within their immediate jurisdiction; and if beyond, it must be visited
four times at least by Visitors appointed by the justices, one of whom
shall be a medical man, and twice at least by two of the Commissioners.
In the course of such visits, inquiries are directed to be made as to
the occupation, amusement, classification, condition, and dietary of the
different patients, and also whether a system of non-coercion has been
adopted or not; and where it shall appear, either to the Commissioners
or to the visiting justices, that a patient is detained without
sufficient cause, they have the power, under certain conditions, of
ordering his discharge. When a patient recovers, the proprietor or
superintendent is required to send notice of such recovery to the person
who signed the order for his reception; and if such patient is not
discharged or removed within fourteen days, the proprietor is required
immediately to transmit a similar notice to the Commissioners or
visiting justices, as the case may be. When a patient dies, the medical
practitioner who attended such patient during his illness is to cause a
statement to be entered in the case-book, setting forth the time and
cause of death, and the duration of the disease of which the patient
died, and a copy of such statement, within two days, must be transmitted
to the coroner. In addition to these specific provisions, the
Commissioners have power from time to time to make regulations for the
government of any of these licensed houses, and they must report
annually to the Lord Chancellor the number of visits they have made, the
number of patients they have seen, the state and condition of the house,
the care of the patients therein, and such other particulars as they may
think deserving of notice (p. vi.).

25 AND 26 VICT., C. 111, "THE LUNACY ACTS AMENDMENT ACT, 1862."

In consequence of the importance of the Act of 1862, the Commissioners
issued the following circular noting its chief provisions:--

Private Patients.

Sec. 23.--The order must be dated within one month prior to reception;
the person signing the order must himself have seen the patient within
one month prior to its date; and a statement of the time and place when
the patient was so seen must be appended to the order.

Sec. 25.--When possible, every order must contain the name and address
of one or more relations of the lunatic, to whom notice of the death of
a lunatic must be sent.

Sec. 24.--Besides the persons hitherto prohibited from signing
certificates and orders, the following also are now disqualified:--Any
person receiving any percentage on or otherwise interested in the
payments for patients, and the medical attendant as defined in the
Lunacy Act, c. 100. Also 15 and 16 Vict., c. 96, s. 12; c. 97, s. 76.

Sec. 26.--Where a patient received as a pauper is made a private
patient, no fresh order or certificate is required, and vice versa.

Sec 28.--With the exception of the statement by the medical officer as
to a patient's mental and bodily condition, all the documents heretofore
required to be sent to the Commissioners after two or before seven clear
days from the reception of the patient, must in future be sent within
one clear day from such reception. The medical officer's statement is,
as heretofore, not to be sent until after two and before seven clear
days.

Letters of Patients.

Sec 40.--Without special directions to the contrary, letters addressed
to the Commissioners, committees of Visitors, committees of a hospital,
and the Visitors of licensed houses, must be forwarded unopened. Other
letters must also be forwarded, unless, by an endorsement thereon, the
superintendent or other person having charge of patients should prohibit
their transmission. Letters so endorsed to be laid before Commissioners,
committees, or Visitors at next visit.

Sec. 38.--Absence on trial may be permitted to patients, in the same way
as leave of absence for the benefit of health is permitted under s. 86,
c. 100.

Sec. 43.--In the absence of any person qualified to discharge, a
discharge or removal may be ordered by the Commissioners.

Pauper Patients.

Sec. 25.--The order must contain the name and address of one or more
relations of the lunatic, and notice of the death of the lunatic must be
sent to such relation.

Sec. 38.--A pauper permitted to be absent on trial from a licensed house
or hospital may have such an allowance made to him by order of the
Commissioners, Visitors, or committees as would be charged for him were
he in the house or hospital.

Licensed Houses and Hospitals.

Secs. 14 and 15.--No fresh licence can be granted by justices without
inspection and report by the Commissioners. Notices of alterations in
houses licensed by justices must be given to Commissioners. Their report
must be considered by the justices before licence is granted or
alterations are consented to.

Sec. 16.--The physician, surgeon, or apothecary not being a licensee,
where any such is by law required to reside in or visit a licensed
house, must in the metropolitan district be approved of by the
Commissioners, and in the provincial district by the visiting justices.

A penalty is imposed on any person infringing the terms of his licence
as to numbers, sex, or class.

Sec. 18.--With consent of two of the Commissioners, or, in the case of
the provincial licensed houses, of two of the Visitors, a person who
may have been a patient within five years immediately preceding, may be
received as a boarder into a licensed house (extension of c. 96, s. 6).

Sec. 29.--Licensed houses may be visited at any time by one or more of
the Commissioners or Visitors, but in the metropolitan district they
must be so visited twice in the year, in addition to the present visits
by two Commissioners, and in the provincial districts similarly by
Visitors. Commissioners and Visitors visiting singly have substantially
the same powers of inspection and inquiry as when visiting together. To
these the sixty-second section of the Act does not apply.

Sec. 39.--A penalty is now imposed on any officer or servant conniving
at an escape.

Sec. 43.--In the absence of any person qualified under ss. 72, 73, c.
100, the Commissioners may order discharge or removal of a patient.

Sec. 38.--Absence on trial may be permitted to patients, in the same way
as leave of absence for the benefit of health is permitted under s. 86,
c. 100.

Medical Certificates.

Sec 27.--Where medical certificates have been returned with a written
direction of the Commissioners for amendment, and such amendment shall
not have been made within fourteen days, the Commissioners may order the
patient's discharge.

Sec. 22.--Lunatics so found by inquisition may be received without
certificate on an order of the committee, accompanied by an official
copy of the order appointing such Committee.[316]

Workhouses.

The Poor Law Board issued a circular at the same time. The only
paragraph which it is of interest to cite here is the following:--"The
eighth section empowers the Visitors of any asylum and the guardians of
any parish or union within the district for which the asylum has been
provided, if they shall see fit, to make arrangements, subject to the
approval of the Commissioners in Lunacy and the President of the Poor
Law Board, for the reception and care of a limited number of chronic
lunatics in the workhouse of such parish or union, to be selected by
the superintendent of the asylum and certified by him to be fit and
proper so to be removed. The Board are at present not aware of any
workhouse in which any such arrangement could conveniently be made; but
they will be ready to consider any such proposals on the subject when
the Visitors of the Board of Guardians of any union shall find it
convenient or practicable to act upon this clause."

FOOTNOTES:

[316] Seventeenth Report of Commissioners in Lunacy, 1863.

APPENDIX H.

(Page 205.)

Extract from the British and Foreign Medical Review, January, 1840:--

"In this particular there is apparently no asylum in England which
presents so remarkable a model as that of Lincoln. Of all the works that
have appeared on the subject of lunatic houses since the publication of
Mr. Tuke's account of the Retreat, there is none which contains matter
more deserving of attention than that recently published by Mr. Hill.
His lecture is little more than a simple commentary on the resolutions
of the board of management of the Lincoln Asylum for twenty years past;
during which period, under the superintendence of Dr. Charlesworth, and
latterly with the vigilant co-operation of Mr. Hill himself, as house
surgeon, almost every kind of bodily restraint is stated to have
gradually fallen into disuse as superfluous, a mere substitute for want
of watchful care.... If the Lincoln Asylum can present a model of this
kind, which all may visit and examine, the services of Dr. Charlesworth
to the cause of humanity and in behalf of the insane, already
considerable, will only be second to that of him who first released them
from their chains."

On this Mr. Hill observes, July 8, 1840:--

"At last the first Medical Review in Europe took up the subject, and
placed most deservingly Dr. Charlesworth in a striking position as to
the non-restraint system, and also honoured myself with approbation."

The following extracts from the Orders in the Lincoln Asylum books[317]
are essential to the right understanding of the introduction of
non-restraint there. Dr. Charlesworth was visiting physician from its
opening in 1821; Mr. Hill was appointed house surgeon in 1835.

"1828. Ordered--That the use of the strait waistcoat be discontinued
in this institution except under the special written order of the
physician of the month.

"1828, October 13. Ordered and resolved--That the physicians be
requested to consider whether it be possible to make any improvement in
the means of restraint now in use, and especially for obviating the use
of the strait waistcoat."

Extract from the Fifth Report of the Lincoln Lunatic Asylum, 1829,
April:--

"The governors have particularly directed their views to the subject of
coercion and restraint, well aware of their injurious consequences to
the patients.... The construction of the instruments in use having also
been carefully examined, they have destroyed a considerable proportion
of those that were not of the most improved and least irritating
description, and hope hereafter to introduce still further amelioration
into this department."

Extract from the House Visitor's Report, 1829, August 17:--

"Every attention seems to be paid to the patients, whose general state
has, I understand, for some time past, been so generally good that it
is gratifying to say that the strait waistcoat has almost become
useless."

Extract from the Seventh Annual Report, 1831, March 28:--

"Heretofore it was conceived that the only intention of a receptacle for
the insane was the safe custody of the unhappy objects, by any means,
however harsh and severe. These views are now passing away, and the fair
measure of a superintendent's ability, in the treatment of such
patients, will be found in the small number of restraints which are
imposed. The new director has answered this test in a very satisfactory
manner."

The new director here referred to was Mr. Henry Marston. The following
note is appended to this report:--

"As early as the 24th day of November last (viz. Nov., 1830, five years
before Mr. Hill's appointment), there was not any patient in the house
under restraint, unless one wearing a collar, which leaves all the limbs
quite at liberty, can be so considered. This gratifying occurrence has
taken place more than once since that time."

Extract from the Ninth Annual Report, 1833, April:--

"It is unceasingly an object in this institution, and should form a
prominent point in the annual reports, to dispense with or improve as
much as possible the instruments of restraint."

Extract from the House Visitor's Report, 1834, August 4th to 10th
inclusive:--

"I have much satisfaction in being able to state that not a single male
patient has been under restraint since the 16th of July, and not one
female patient since the 1st of August, and then only for a few hours."

At this time Mr. Hadwen held the appointment of house surgeon.

Extract from the Governor's Memorandum Book, 1835, July 8th:--

"Resolved,--That this Board, in acknowledging the services of Mr. Hadwen
during the period of fifteen months that he held the situation of house
surgeon of this institution, feel called upon to express their high
approbation of the very small proportion of instances of restraint which
have occurred amongst the patients under his care."

Extract from Edinburgh Review, April, 1870:--

"But to Conolly belongs a still higher crown, not merely for his courage
in carrying out a beneficent conception on a large scale and on a
conspicuous theatre, but for his genius in expanding it. To him, hobbles
and chains, handcuffs and muffs, were but material impediments that
merely confined the limbs; to get rid of these he spent the best years
of his life; but beyond these mechanical fetters he saw there were a
hundred fetters to the spirit, which human sympathy, courage, and time
only could remove.

"Perfect as was the experiment carried out at Lincoln Asylum, the
remoteness of that institution from the great centre of life, and the
want of authority in its author, would no doubt have prevented its
acceptance for years by the physicians of the great county asylums so
long wedded to old habits. It was for some time treated as the freak of
an enthusiastic mind, that would speedily go the way of all such
new-fangled notions; and no doubt it would, had not an irresistible
impulse been given to it by the installation of Dr. Conolly at Hanwell,
where, with a noble ardour, he at once set to work to carry out in the
then largest asylum in the kingdom the lesson he had learned at
Lincoln."

Dr. Conolly's works bearing on mental disorders, in addition to his
"Lectures on Insanity," were as follows:--

1. "An Inquiry concerning the Indications of Insanity, with Suggestions
for the better Protection and Care of the Insane." 1830.

2. "The Construction and Government of Lunatic Asylums and Hospitals for
the Insane." 1847.